Medicare Compliance & Reimbursement

Ever since CMS began to pay for annual wellness visits (AWVs) and Welcome-to-Medicare (WTM) exams, practices have questioned whether non-physician practitioners could bill for these services. CMS has finally included that information as part of its "Preventive Services Frequently Asked Questions" file, which the agency published on July 9.

According to the document, the following practitioners can perform an AWV: physicians (doctor of medicine or osteopathy), physician assistants, nurse practitioners, clinical nurse specialists, medical professionals (including a health educator, a registered dietitian, nutrition professional, or other licensed practitioner) or a team of such medical professionals working under the direct supervision of a physician (doctor of medicine or osteopathy).

As for the WTM, also referred to as the Initial Preventive Physical Exam (IPPE), Medicare will cover the exam if one of the following staff members performs it: physician (doctor of medicine or osteopathy) or other qualified non-physician practitioner (physician assistant, nurse practitioner, or clinical nurse specialist).

CMS stresses that the practitioners must be working within their state scopes of practice. For more on CMS's preventive care FAQs, visit www.cms.gov/Outreach-and-Education/Outreach/NPC/Downloads/IPPE-AWV-FAQs.pdf.

Senior Medicare Patrol Program Boosts Its Ranks

The Senior Medicare Patrol Project is stepping up its activity. In 2011, the 54 Senior Medicare Patrol Projects had 5,671 active volunteers, a 14 percent increase from 2010, the HHS Office of Inspector General says in a new report published on June 21. Volunteers conducted 66,303 one-on-one counseling sessions and 11,109 group education sessions. In 2011, 431,128 beneficiaries attended group education sessions, an increase from 298,097 in 2010.

Medicare funds recovered due to the projects were $19,283 in 2011. But don't let that number fool you, the OIG says. The projects saved another $248,000 in "cost avoidance." And the projects referred some "large-dollar cases," the OIG notes. Medicare is seeking to recover $2.9 million in one of them.

New York and California had the most Senior Medicare Patrol volunteers, while Kansas and Oklahoma had the fewest. The study is online at http://go.usa.gov/vda.

CMS Tweaks Pulmonary Rehab Coverage

CMS has allowed payment for physician-supervised pulmonary rehab programs since 2010, but the agency is still tweaking the policies to confirm that only patients with moderate to very severe COPD are entitled to the benefit.

Background: Effective Jan. 1, 2010, physician-supervised comprehensive pulmonary rehab programs have been payable for up to two hourly sessions per day, up to 36 lifetime sessions. The programs must include physician-prescribed exercise, education or training, psychosocial assessment, outcomes assessment, and an individualized treatment plan.

Update: On July 16, CMS revised MLN Matters article MM6823 to clarify that the benefit is only payable for patients with moderate to very severe chronic obstructive pulmonary disease (COPD).

To read a complete copy of the article, visit www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM6823.pdf.

Whistleblower Lawsuit Leads To Hospice GIP Settlement

You'd better make sure your general inpatient hospice claims are well documented, because the government's campaign against fraudulent GIP billing continues.

Case in point: AHH Historic Inc. hospice in Atlanta will pay $555,000 to settle charges that it upcoded GIP days, says the FBI in a release. The government alleges that AHH, formerly known as Altus Healthcare & Hospice Inc., submitted false claims to the Medicare and Medicaid programs for GIP care for patients who did not qualify to receive that level of hospice care from 2008 to 2011.

The settlement is a result of a False Claims Act suit filed by whistleblower David C. Boal, who will receive part of the settlement. Boal is identified in a 2008 Gainesville Times news article as a hospice worker.

"Altus Healthcare allegedly milked Medicare's hospice benefit to increase their own profit as much as possible," Derrick Jackson, Special Agent in Charge of the HHS Office of Inspector General for the Atlanta region, says in the release. The OIG "is committed to eliminating this greed from our nation's health care system."

Altus was acquired by Halcyon Healthcare in December 2011.